title: The impact of comprehensive stroke care capacity on the hospital volume of stroke interventions: a nationwide study in Japan: J-ASPECT study.
abstract: BACKGROUND
  The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions.
  
  
  METHODS
  A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009.
  
  
  RESULTS
  Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001).
  
  
  CONCLUSIONS
  We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: kiihara@hsp.ncvc.go.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.affiliation: Department of Preventive Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Advanced Medical Technology Development, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kada
authors.affiliation: Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Iwate, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.affiliation: Chiba Cardiovascular Center, Chiba, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ono
authors.affiliation: Department of Neurosurgery, Kyorin University, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.affiliation: Showa University Hospital, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Aruga
authors.affiliation: Department of Neurosurgery, Nagoya University, Nagoya, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyachi
authors.affiliation: Department of Neurosurgery, Nagasaki University, Nagasaki, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
authors.affiliation: Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
authors.forename: Koichi B
authors.initials: KB
authors.lastname: Ishikawa
authors.affiliation: Research Institute for Brain and Blood Vessels, Akita, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hisae
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Healthcare Epidemiology, Faculty of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Nakamura
mesh_terms: D003191:Comprehensive Health Care / Q000639:trends*; D019033:Delivery of Health Care, Integrated / Q000639:trends; D004621:Embolization, Therapeutic / Q000639:trends; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends; D061847:Hospitals, High-Volume / Q000639:trends*; D061846:Hospitals, Low-Volume / Q000639:trends*; D006801:Humans; D007564:Japan; D016014:Linear Models; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000639:trends; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010348:Patient Care Team / Q000639:trends; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000639:trends; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke facilities; acute stroke therapy; intracerebral hemorrhage; ischemic stroke; stroke units; subarachnoid hemorrhage